(Hartford, CT) — Attorney General William Tong today announced a $1 million settlement with Robinson PA, LLC d/b/a PCA Pain Care Center (PCA) and its owner Benjamin Robinson to resolve allegations that they overbilled the Connecticut Medicaid program and violated the Connecticut False Claims Act.
PCA is a pain management practice in Wallingford, Connecticut. The Office of the Attorney General initiated an investigation after a referral from the Department of Social Services. DSS had identified some questionable billing patterns that suggested PCA may have been overbilling the Connecticut Medicaid program.
Healthcare providers must submit claims for office visits to Medicaid that contain a billing code, known as a CPT code, that accurately describes the services provided. This code determines how much Medicaid reimburses the provider. The Office of the Attorney General’s investigation focused on whether starting in 2013, PCA “upcoded” or used codes that would reimburse their office at a higher rate than PCA deserved when submitting claims for services they provided to patients.
The settlement resolves the allegations that PCA and Robinson submitted claims to Medicaid for their patients’ office visits that they knew, or should have known, were submitted with a billing code for a higher level of service than the services delivered by PCA’s providers merited. The Office of the Attorney General alleged that PCA coded nearly all its claims for its office visits...
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